Pet Spotlight/Case Study: Maxine’s Perianal Fistulas

Maxine was first presented to Dr. Ho as a 5-year-old, female spayed, German Shepherd dog for an evaluation of recurrent anal gland issues. Her owner reported that Maxine had a several month history of licking her rear, straining to defecate, and seemed uncomfortable when touching her tail. Maxine has a history of atopic dermatitis (environmental allergies) that started at 2 years of age, which was managed with Apoquel, an anti-itch medication.

Maxine was first treated with an antibiotic for suspect anal saculitis (inflammation of the anal glands). Her symptoms improved, but then recurred after the antibiotic course was finished. When she presented to Dr. Ho, Maxine was in discomfort during the examination, especially when examining her rear. Maxine had several small draining tracts that exuded a blood-tinged discharge around her anus. The bottom of the tail was also inflamed and ulcerated.

Maxine Before

Based on history and physical examination, Dr. Ho diagnosed Maxine with perianal fistulas.

Perianal fistula is an immune-mediated chronic inflammatory disease that affects the tissue around the anus. Management of this condition requires immune suppressive drugs including corticosteroids and cyclosporine.

This is a condition that is not curative, and therefore, life-long therapy is often needed. Most also have a secondary bacterial infection that needs to be treated as well.

In Maxine’s case, she was placed on both an antibiotic, a corticosteroid called prednisone, and Atopica (veterinary formulation of cyclosporine). The goal is to use the lowest effective dose of both anti-inflammatory medications while keeping Maxine in clinical remission (lesions have resolved). Corticosteroids are typically weaned first due to long-term adverse effects.

Maxine was in clinical remission within the first 1.5 months of therapy. Currently, she remains healthy receiving Atopica daily.